California Dual Eligibles Transition Sparks Worries

California could set a national precedent with implementation of its Cal MediConnect duals demonstration project, which is scheduled to begin implementation April 1. Eventually the program will shift one million frail and elderly Californians into managed care plans.

The pilot project combines the disparate services and financing of Medicare and Medicaid (in California known as Medi-Cal) for people who are eligible for both programs. Beneficiaries — known as dual eligibles — would theoretically get better care and more services in an integrated approach, and the state would save money by combining the finances from the two entitlements.

California’s duals project, one of 15 state pilots approved by CMS to help design new approaches for coordinating care, is by far the largest in the country.

The pilot project has gone through extensive stakeholder meetings and government hearings and its launch date has been delayed several times in an effort to ensure the project runs as smoothly as possible for such a fragile population.

At the start of January, the state sent 90-day notices to approximately 456,000 Californians in eight pilot counties, letting them know changes were coming. Also in January, the state released its enrollment timeline for the project.

Those milestones have been greeted with a distinct lack of enthusiasm from advocates for seniors and the disabled. Concerns persist about this ambitious pilot project. Some advocates say providers, patients and health plans are confused about how this shift will happen and certainly aren’t prepared for changes of this magnitude.

No official from the state Department of Health Care Services was available to discuss the issue or answer specific questions. However, DHCS staff members did release a general written response.

“The goal of this effort is to improve care coordination for these individuals and provide high quality services efficiently and effectively. The current system is fragmented, increasing the risk of confusion, delayed care and unnecessary costs. As we begin this transition, we are working to ensure that Cal MediConnect beneficiaries have the information and resources they want and need,” the email response said.

The program had an unexpected downsizing last week when CMS officials halted new enrollment in the special-needs plan of CalOptima. Since CalOptima is the only insurer for Orange County in the duals project, that temporarily trims the eight-county demonstration plan down to seven counties.

Orange County has the second-largest population of dual eligibles in California, so the state will have 57,000 fewer duals to handle in the transition, at least until CalOptima can meet CMS requirements.